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;FOR OFFICE USE: �! t j APPLICATION FOR SANITATION PERMIT ; -- -- -----------------------------•----- -------------- �I p(Com lete in Triplicate) �, # Permit No.7L:____S_-�_ ---------------------------------------- �1..p R ;' a This Permit Expires 1 Year From Date Issued pate Issued ___.__ Application is hereby made to the San Joaquin Local Health District for a per to 'construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -------- - . 1---� ��-��'- - - - ---- CENSUS TRACT --------------------------- Owner's Name ------(�,------ --�----i------T-- 6- A7IVI-----------------------:=----------------•-------------------Phone --- -- -- Address --------- 424_S Ole ----?-D------------------------. City -----------------------..... -•------ Contractor's Name --- -��_.L_c_..:!-'�_IJ-- ��ment f�,�- ------------------------License # �7�-5`*;9_ Phone Installation will serve: Residence House❑ Commercial :❑Trailer Court ''0 ~ Motel ❑Other ------------------------------------------- Number of living units:--- Number of bedrooms _t2,-.-.Garbage Grinder ------------- Lot Size 'ft __.___`--------------______ Water Supply: Public System and name ---------- ------ --•---------------------------------------------------------•-------------------Private Q� i Character of soil to a depth of 3 feet: Sand W Sift❑ 'Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam 0 Ii Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type -------- (Plot plan, showing size of lot,p,location of system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, f PACKAGE TREATMENT [ I SEPTIC TANK'f ] , Size------------------------------------------------ Liquid Depth ---------------:---------- Capacity -------------------- Type -------------------- Material----------------- --- No. Compartments r � a Distance to nearest: Well _____________________________________Foundation ---------------------- Prop. Line _____________:___---- LEACHING LINENo:Tof Lrines ..__ --___ _ :_ __-. -_ Length of each line----------------_. Notal Length y"'°----------------_........ � [ ] _ : ; : - 'D' Box '------.----- Type Filter Material -------------'------Depth Filter, Material ----------------------------------- ........ Distanceto -nearest: Well -------------------------- Foundation --------- Property Line , SEEPAGE PIT ['j Depth __'______________ _ Diameter ________________ Number ----------------------------- Rock Filled Yes ❑ No C1 Water Table Depth --`.---------------------------Rock Size -------------------------------- E Distance jo nearest: W�ell,_ _-___-__.:4______________________....Foundation __--____________ 1P rop. Line -------.------:___:.__ i - _ REPAIR/ADDITION(Prev. Sanitation Permit# - --------------- --------------------------: Date ---------------------------------- % --------------------------------- �Se tic Tank (SpecifyYRe Requirements) ____-__-_o ;------------• ----------------- ---------------___,-_ __�_r Disposal Field (Specify Requirements) ------ '�--=----- lr6 h---- ------ tl - - ------- ---------------------------------------, ---------- 141 __ ---- � ------------- - ------ '------------- - - -- --------------------------------------- ---------------------- _ �Draw•existing and required addition ori reverse side) � I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances,-State Laws, and Rules and Regulations of`th'e.San Joaquin Local Health District. Home owner cen- T sed agents signature certifies the following: A �3t 4 "I certify that in the performance of the work for which this permit is.issued, I shall not employ any person in such manner g as to become sub'ect'to Workman'sCompensation laws of California.' Si � ------------------------------------- Owner M Signed ----- f+ G1 i 13Y ------------------' ------- -----:--------------------------------------- Title ---------------`------ -------------------=----------------------------- (if other than owner) ° I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------�----------------------------------------------- ------------. DATE'-�--------------/J- -r-=--------- BUILDINGti ADDITIONAL OIMMENTS --------- 1--_---------------------- ------------------------------------ --------------------DATE -------------•--- --------------------- ----------------------- - ------------------- - Final Inspection by: Date � - �. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 . 1-'68.Rev. 5M . ,y